Killing Traditional Nursing Duties #2

This 2006 image depicted an adolescent female ...

Editor’s note: In early August, on our Facebook page, we asked if there were “old nursing habits” that should be killed off. We received a lot of feedback, which we described in a blog post, “Killing Traditional Nursing Duties #1.” We’re back now with feedback from our second question: “When you give IM injections, what site do you most often use—dorsogluteal (upper outer quadrant of
buttocks), ventrogluteal (lateral hip), or deltoid (upper arm)? Why?”

Hands down, the deltoid injection site was preferred for intramuscular (IM) injections, especially for immunizations and if the patient was an adult. (“People don’t have to drop their drawers” was my favorite reason cited.) A few of those who favored that site noted that, if they didn’t use the deltoid (because of the volume of the injection), they would then go to the ventrogluteal site. One person preferred the vastas lateralis (the outer middle third of the thigh), which wasn’t listed as a choice, but is certainly a site that’s used, especially in infants. And several respondents said they prefer the dorsogluteal site. Reasons given were “more comfort” and “more muscle.”

This is actually contrary to current evidence and teaching, which is that the preferred site is the ventrogluteal site. As noted in an article we did in February 2010, evidence indicates we should avoid the dorsogluteal site because “it poses unnecessary and unacceptable risks of […]

2016-11-21T13:11:59-05:00September 6th, 2011|nursing perspective, nursing research|3 Comments
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Caring for Suicidal Children in the ED

By Sylvia Foley, AJN senior editor

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and […]

2016-11-21T13:12:00-05:00September 1st, 2011|Nursing|0 Comments
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Hurricane Aftermath

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Well, Hurricane Irene has come and gone in the northeast United States. While it certainly destroyed property, downed power lines, and caused flooding, many are thinking that we escaped the worst, since Irene morphed from a hurricane into a tropical storm when it made landfall in Long Island, New York.

This is not to diminish the tragedy that it caused—in loss of life (CNN reports 25 Irene-related deaths)  and destruction of property.  And I sympathize with those who experienced flooding or lost power. Cooking, showering, and basic daily activities become major challenges and require ingenuity, creativity, and sometimes a touch of genius. While initially this merely seems inconvenient, after a few days it’s exhausting. I’m sure there will be many households without power for weeks, judging from some local news reports.

An important potential health hazard that wasn’t covered in depth on the news is walking or wading in flood waters in shorts and bare feet or flip-flops. Flood waters often contain contaminants from storm drains and sewers, including raw sewage (as one news reporter discovered only after he was covered in it). Debris, sharp objects, and even power lines may be hidden underwater, as well as ditches or drains (47-year-old postal worker Ronald Dawkins, from Orange, New Jersey, was killed when he tried to wade through rising water to a postal facility where he worked and stepped into a hidden drainage creek).

The Centers for Disease Control […]

2016-11-21T13:12:02-05:00August 29th, 2011|Nursing|0 Comments
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Patient Privacy and Company Policy: What Nurses Should Know About Social Media

Should you be able to have an online discussion about hospital policies that aren’t working or are unfair? What if the point of your discussion is to improve working conditions or to troubleshoot and not to cast an uncomplimentary light on your employer? Right now, the answer is “good question.”

If you’re a nurse or health care worker of any sort, if you sometimes use one or more of the many available social media options (Facebook, blogging, Twitter, etc.), if you’re worried about what it’s OK for you to do or say online, if you have a job or are thinking of looking for one, we strongly suggest you take a look at this month’s iNurse column in AJN (quoted above).

In it, Megen Duffy, RN, aka blogger Not Nurse Ratched, considers such issues as the following:

  • hospital social media policies (always read them; some are surprisingly restrictive)
  • HIPAA and potential issues raised by blogging about aspects of work
  • the ways your social media history may be mined by HR departments at prospective employers
  • the reasons why she strongly believes that social media isn’t going away and has many potential benefits, despite various well-publicized pitfalls—and why nurses need to let their input be known so that social media policies will be sane and balanced

And, since this is social media, we hope you’ll let us know your thoughts, in the form of comments. Maybe Megen will even weigh in, if you […]

2016-11-21T13:12:03-05:00August 26th, 2011|career, healthcare social media|4 Comments
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Killing Traditional Nursing Duties #1

By Shawn Kennedy, MA, RN, AJN editor-in-chief

We recently had a lot of feedback to a question we posted on our Facebook page: “We know old habits die hard and nursing has a lot of them. What old habits do you think we should kill? NPO after midnight? Routine temps on every patient?”

We got several good responses:

– Waking patients up at 4am for blood drawing, routine vital signs

– Measuring intake and output on every patient

– Taking routine temps

– Giving dorsogluteal IM injections

– Doing a skin prep for an IV by swabbing the site in a circular motion, inside to out (some manufacturers of products are instructing that skin prep be done by a scrubbing motion)

– Enemas before childbirth

– Double documenting

– Rushing to give medications right on time (which makes one prone to error)

– NPO after midnight

Choosing from the above, we then asked this: “Survey question #1: Do you routinely wake patients up at night to check their vital signs? If not, when would you?”

This question received many comments, from “Of course not” and “only when necessary” to “If a doc orders q 4 vs and you don’t do it and something happens to the patient, that would not be good for you AT ALL.” Also this: “Orders are orders which we must follow.”

Commenters cited several stories of recent postoperative patients (who, I agree, should have vital signs frequently monitored) who could have suffered grave consequences had the nurse not woken them […]

2016-11-21T13:12:04-05:00August 24th, 2011|healthcare social media, nursing perspective|6 Comments
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